The subject is a 52 year old divorce Caucasian female, of Poland origin, and has lived in the United States for over 20 years. She had been a patient at Tewksbury Hospital since July 2011. She reportedly has a long history of bizarre and impulsive behavior, but has had a steady decline since her divorce in 2004. The patient denies history of taking medication or hospitalization for mental illness. There is no history of mental illness in the family. The subjects states, “My work is very unique. It’s inspirational spiritual work.
I work as a self- healer. I do not need to see a physician for any diseases.” She went on saying “I have experienced terrible aggression. I am a psychologist. I can do many professions which I do not wish to discuss.” The subject lives in a house in the Boston area, where the rooms are rented and they share a common kitchen. She violated a no-harassment order against another residential by coming into the common kitchen, picking up a knife, and startled the alleged victim. She denies SI/HI. She said she had thoughts of “going to sleep”, but has no plan for SI.
She denies trauma, physical abuse, sexual abuse/ rape. She started smoking at the age 12, 20/day. She was admitted to Tewksbury Hospital with a legal status 15, and then later changed to 16c and 8. She was diagnosed with Axis I: Psychosis NOS and Adjustment disorder (unspecified), Axis II: Deferred, Axis III: right shoulder pain, Axis VI: Homeless, limited community support, GAS: 35.
Signs and Symptoms Psychosis is a serious psychiatric disorder in where there is a gross disorganization of the personality and marked disturbance in reality, testing and the impairment of interpersonal functioning and relationship to the external world (Townsend 2009). It may cause a person to experience delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior. Psychotic Disorder Not Otherwise Specified 298.9, is used in diagnosing patient when their symptoms to not meet any of the psychotic disorder. Multiple examples would include:
1) delusions with periods of overlapping ME, 2) post-partum psychosis, 3) psychotic disorders with less than one month duration with no remission, 4) psychotic disorders with unknown etiology, 5) persistent auditory hallucination. Adjustment Disorder is a psychological response to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioral symptoms. The symptoms must develop within three months after the onset of the stressor(s). Unspecified Adjustment Disorder may be used as a diagnosis if the patient cannot be classified into a specific subtype of Adjustment Disorder. The patients have maladaptive reactions to stressors, and they may include: physical complaints, social withdrawal, or work or academic inhibition.
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